With the nursing shortage intensifying and expected to triple over the next 13 years, this issue of Georgia Nursing is dedicated to the needs of direct care staff nurses and the importance of the promotion of safe staffing principles.

Recently more than 10,000 nurses nationwide participated in ANA’s Safe Staffing Saves Lives poll.  Nearly 75 percent of the respondents were staff nurses and 83.4 percent worked in a hospital setting. Less than 22 percent of the respondents worked in a Magnet facility where healthcare organizations are recognized for promoting safe, positive work environments. More than a majority of respondents said they knew of someone who left direct care nursing due to concerns about safe staffing and nearly two-thirds felt the staffing on their unit or shift was insufficient. The full results of the poll can be found online at: http://www.safestaffingsaveslives.org/WhatisANADoing/PollResults.aspx 

One of GNA’s and ANA’s core competencies is to promote state and federal legislation that supports and protects the practice of nursing. GNA has enabled such legislation as state whistleblower protection and the requirement that all RN nametags display the RN designation so patients and families can clearly identify who is the RN on staff. At the federal level, ANA currently supports the proposed Registered Nurse Safe Staffing Act (S.73/H.R. 4138) that is consistent with ANA's Principles for Nurse Staffing. It holds hospitals accountable for establishing valid, reliable, unit level nurse staffing plans. These plans will be developed in consultation with direct care RNs and based on each unit's needs and characteristics. Hospitals also will be required to post daily public reports of staffing levels and provide whistleblower protections for RNs and others who might file a complaint about staffing. ANA has proposed solutions to the staffing crises facing this nation through the RN Safe Staffing Act and the Principles of Safe Staffing, Principles of Delegation, and Principles of Documentation.  By involving nurses in the creation of staffing plans based on unit-by-unit circumstances and patient needs, safe staffing can exist. Given the strong evidence supporting positive links between safe staffing and quality patient care, the ANA published the Principles on Safe Staffing and the Utilization Guide to the Principles on Safe Staffing to guide the development of valid and reliable nurse staffing plans. ANA does not support fixed nurse-patient ratios.

A newly published study by Marilyn Chow, vice president of patient-care services for Kaiser Permanente and Ann Hendrich, vice president of clinical excellence for Ascension Health used hand-held computer and motion sensors to track the movement and tasks of 760 medical-surgical nurses. The results did not vary significantly across three floor plans included in the study. What they found was that documentation absorbed the most time using 2.5 hours of a 10 hour shift. Medication administration required 72 minutes and patient assessment and tracking of vital signs took about a half hour. Nurses spent another hour and a half coordinating care and 81 minutes on direct care. Thirty-six minutes of a 10-hour shift were wasted on waiting, delivering and searching.

ANA has a comprehensive plan to ensure quality patient care and improved working conditions for RNs. ANA and GNA believe that providing nurses with the authority to establish staffing plans with the ability to adjust based on patient acuity, staff experience and skill mix, and available support and resources may only be possible through legislation. Unlike a fixed staff-to-patient ratio system, unit-based safe staffing plans are not a "one size fits all" approach to staffing. Instead, they tailor nurse staffing to the specific needs of each unit, based on factors including patient acuity, the experience of the nursing staff, the skill mix of the staff, available technology, and the support services available to the nurses. Most importantly, this approach treats nurses as professionals and empowers them to have a decision-making role in the care they provide. Conversely, the much touted fixed staffing ratio legislation promulgated by unions in California have not validated any improvement in patient outcomes since its implementation.  Fixed staff-to-patient ratios do however benefit the financial coffers of the unions themselves. It is important to separate rhetoric from research when it comes to staffing. Preliminary evidence from a study of 4,000 RNs across 10 states shows a link between staffing plan legislation and positive work environment perceptions among RNs when compared with either mandatory fixed staffing ratios or no workforce regulations (Cox,K.S., Anderson, S.C., Teasley, S.L., Sexton, K.A., & Carroll, C.A (2005)

For more than a decade, research has shown significant links between safe staffing levels and positive outcomes for hospitalized patients.  Nursing-sensitive indicators, such as those found in ANA’s National Database of Nursing Quality Indicators (NDNQI) ®, administered by the University of Kansas School of Nursing, offer measures of the nursing workforce through nursing hours per patient day, processes of care and patient outcomes. The NDNQI, a repository for nursing-sensitive indicators, is the only database containing data collected at the nursing unit level. Data collected at over 1300 hospitals nationwide provide nurses the information they need to develop unit-based staffing plans and clearly illustrate that professional safe staffing means better patient care!  

While the direct care staff nurses continue to advocate for their patients, GNA advocates for the staff nurses and educates and communicates with legislators, the public and with other health care system stakeholders about their value to the community and to the health of Georgia’s citizens.

Deborah Hackman is GNA/GNF Chief Executive Officer.

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